Preventing Harm in Perioperative Care: Epidemiological Surveillance, Patient Safety Culture, and Healthcare Quality Improvement

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Abstract
Perioperative patient safety remains a major challenge for healthcare systems worldwide, as preventable adverse events continue to contribute to postoperative morbidity, avoidable mortality, prolonged hospitalization, and increased healthcare costs. This narrative review aimed to analyze the epidemiological burden, clinical determinants, and organizational factors associated with preventable perioperative adverse events, emphasizing the contribution of epidemiological surveillance, safety culture, and continuous process improvement. Twenty scientific publications were examined, integrating international evidence with investigations conducted in Latin America. A descriptive and comparative analytical approach was employed, using the Define, Measure, Analyze, Improve, and Control (DMAIC) framework to organize the evaluation of patient safety challenges and preventive strategies. The reviewed evidence identified surgical adverse events affecting approximately 14.4% of patients, with potentially preventable events affecting 5.2%. International studies demonstrated reductions in postoperative complications and in-hospital mortality following the implementation of standardized surgical safety checklists and comprehensive perioperative safety systems. Latin American investigations documented a substantial burden of healthcare-associated adverse events, with nearly 60% of identified events considered potentially preventable in the Iberoamerican Study of Adverse Events. Additionally, institutional quality improvement initiatives demonstrated marked increases in anesthesia-related incident reporting, highlighting the importance of distinguishing improved surveillance capacity from changes in actual patient harm. The findings indicate that sustainable perioperative safety depends on coordinated clinical protocols, reliable epidemiological monitoring, multidisciplinary communication, institutional leadership, and continuous organizational learning. Strengthening these interconnected components may contribute to reducing avoidable harm and improving surgical care quality, particularly in healthcare environments characterized by heterogeneous resources and institutional capacities.